Inflammatory bowel disease (IBD) is a term that describes chronic inflammation of the digestive tract, the two main types of which are Crohn’s disease (which can affect any part of the digestive tract) and ulcerative colitis (specifically affecting the large intestine). Identifying the physiological imbalances that are contributing to IBD is crucial to the development of a targeted, individualized treatment plan. After taking a full history and conducting physical exams as appropriate, your ND may recommend certain tests to evaluate your digestive health. One particularly helpful way to evaluate IBD disease activity and severity is through advanced stool testing.
Typical stool testing that is available in the conventional medical system is used to investigate the presence of certain pathological species of bacteria, sometimes some parasites, and blood in the stool. The information that such stool tests reveal may sometimes be helpful, but is often quite limited. For this reason naturopathic doctors may recommend more advanced, comprehensive stool testing that is done through private laboratories, and which is not available through MSP. Here’s an overview of what is evaluated with advanced stool testing, and why it’s important in IBD:
- Bacterial cultures: both the presence and quantity of a broad selection of bacterial species are identified, including: expected beneficial species (showing whether these are present in sufficient amounts for the benefit of gut health), commensal species (species that are not pathological by themselves but which may cause inflammation when they our out of balance with the rest of the intestinal flora), and harmful bacteria that directly contribute to pathology – several of which can be directly implicated in IBD.
- Yeast cultures: there should be only very small quantities of yeasts (such as candida spp.) in the intestines, and overgrowth can be problematic.
- Parasitology: some advanced stool tests include an analysis of parasites in the stool that can increase inflammation, intestinal permeability (“leaky gut”), and disrupt immune function.
- Digestion/Absorption markers: the presence of poorly broken-down dietary substances gives an indication of digestive insufficiencies and poor nutrient absorption.
- Inflammatory markers: these are very specific markers of inflammatory activity in the intestines, and help to differentiate true IBD from irritable bowel syndrome (IBS). Monitoring levels of these markers gives a good indication of the effectiveness of IBD therapies, and they are good predictors of remission.
- Secretory IgA (sIgA): sIgA is a type of protective antibody secreted by immune cells in the intestines, and is the first line of defense of the gastrointestinal mucosa. Elevated levels indicate an up-regulated immune response, whereas deficient levels indicate that the gut immune system is depressed.
- Short-chain fatty acids (SCFAs): these are products of the fermentation of dietary fibre by beneficial bacteria. The adequate production of SCFAs lowers the pH of the large intestine (i.e. makes it more acidic), which makes the environment unsuitable for the growth of pathogens. SCFAs decrease inflammation, stimulate healing in the gut, and help to maintain good cell differentiation (poor “differentiation” would mean that healthy cells are in the process of becoming cancer cells).
- Intestinal health markers: this includes an assessment of the pH (acidity) of the large intestine, and the presence of red blood cells and occult blood in the stool.
- Pathogen susceptibility report or antibiotic resistance report: depending on the test that is conducted, either of these may be included. A pathogen susceptibility report provides a list of the herbal and pharmaceutical antimicrobial substances that are most likely to eradicate the pathogens that are present. An antibiotic resistance report indicates the presence of antibiotic-resistant genes in the bacteria in the large intestine, giving an indication of which antibiotics would be the least or more likely to work to eradicate infections.
Naturopathic doctors are equipped to address imbalances in any of the items reported in an advanced comprehensive stool test. If you’re wondering whether a stool test may be beneficial for you, your naturopathic doctor can provide you with guidance and support. To book your appointment today, for Victoria phone 250-590-7809 and for Vancouver phone 604-697-0397.